Coverage for Dental Specialists

Posted on April 5, 2018 in Dental benefit information

The trees are blooming and their roots are growing. But what happens if the roots of your teeth aren't doing so well? Learn how your dental benefits work when you're referred to an endodontist for a root canal or when you need to see another dental specialist

There are multiple reasons you might need to visit a specialist. Here are just a couple:

  • If you have a problem with your tooth nerves or pulp, your dentist may determine that you need to see an endodontist.
  • If you have issues with your gums and surrounding areas, a periodontist can provide the right care.
  • For more complex or difficult problems requiring surgery in the oral cavity and maxillofacial area (the face and jaws), you may be treated by an oral surgeon.

In most cases, your dentist will refer you to a specialist, but you may not be required to have a referral for your benefits to apply. Check your plan to find out if you need a referral to see a specialist.1

Once you know what kind of care you need, the best way to save on your procedure is to visit an in-network specialist. With a Delta Dental of Illinois plan, you are free to see any licensed dentist, including specialists. However, you will save the most money by visiting a dentist who participates in the Delta Dental PPOSM network. You will also save more money with a Delta Dental Premier® network dentist compared to a non-network dentist. You can use the Provider Search tool on or Delta Dental's free mobile app to find a network dentist or specialist near you.

When visiting a specialist, a pre-estimate (also called pre-authorization or pre-determination) can help you and your dentist determine the cost for a certain procedure. Although not required, Delta Dental of Illinois recommends a pre-estimate for procedures over $200.  A pre-estimate will let you know how much of the cost will be covered by your plan and how much you may need to pay out-of-pocket.

With some research upfront, you can ensure you're making a smart decision about which specialist to see to have your smile healthy again in no time.